Gliederung

Introduction

Traditionally total knee replacement has been performed through a long anterior incision that not only affects aesthetics but chiefly inflicts significant trauma to the soft-tissues. The standard capsular incision disrupts the suprapatellar pouch. Moreover, everting the patella and forcing the knee into hyperflexion derogates the extensor-mechanism. These important provisos of the conventional method are overcome by the new minimal-invasive technique. However, some surgeons report deception not gaining sufficient exposure and compromising their results. Technical tips and tricks can be helpful.

Materials and Methods

Based on the experience of over 250 total knee replacements done through a mini-midvastus approach the senior author developed an algorithm to facilitate the surgical procedure, to optimize the exposure and to minimize the amount of soft-tissue trauma.

Results

Less pain, easy recuperation and rapid return of flexion were the immediate results after MIS knee replacement. The total amount of morphine sulphate equivalents used and VAS-pain levels were significantly lower compared to the standard procedure group. Flexion was significantly better during the first days after operation and after six weeks as were knee scores. There was no difference in the excellent alignment and position of the components in both groups and all knees were stable.

Discussion

Using the new technique and respecting the premise of minimal trauma to the soft-tissues rehabilitation and function in the first weeks after knee surgery can be significantly improved. Yet, to fully benefit from MIS certain provisos should be known and some practical recommendations should be taken into consideration.